Canada

KAIN000273371

Prenatal Massage Release Form

Prenatal Massage Contraindications
Massage therapy during pregnancy has been shown to be beneficial for a number of common complaints such as fatigue, musculoskeletal pain, sciatica, edema, and many others. However, there are risks associated with specific conditions that may occur during pregnancy.
You must inform your massage therapist/practitioner if you have or have had in the past any of the following conditions or symptoms which may make massage therapy during pregnancy contraindicated or may require your therapist/practitioner to alter the massage.

• History of miscarriage
• Gestational Diabetes
• Cardiac, pulmonary, liver, or renal disorders
• Mother’s age under 20 or over 35
• Pitting edema
• Epilepsy or other convulsive disorders
• Placental or cervical dysfunction
• Abdominal pain
• Leaking of amniotic fluid
• Fever
• Sudden edema/swelling
• Severe headaches
Client’s Release
• Preeclampsia
• History of any high-risk pregnancy
• Drug exposure
• Multiples
• Hypertension
• Genetic abnormalities
• Fetal growth retardation
• Bloody discharge
• Sudden weight gain
• Diarrhea
• Decrease in fetal movement over a 24-hour period • Severe nausea or vomiting

A 5% GST Tax will be added to all prices

Prenatal Massage $76.99 First Visit, Moving Forward $80.84

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Kinniss Therapeutic Massage Inc.

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KAIN000273371